[Reprinted from The Medical News, June 16,1894.] 
CRAMMING IN OUR MEDICAL SCHOOLS) 
By OSCAR H. ALLIS, M.D., 
SURGEON TO THE PRESBYXMWffN HOSPITAL. 
A few years ago the ease with which a medical 
diploma could be obtained led to the passage of a 
law in many of the States that necessitated a three 
years' attendance upon a graded course of medical 
lectures. The effect of this has been the multipli- 
cation of professional chairs. In addition to the 
seven original professorships there are now a much 
greater number of honorary professorships. 
With the increase in the length of the term and 
an increase in the teaching staff, there has grown 
up a remarkable change in the mode of instruction, 
and this is especially observable in the effort to 
make the course as practical as possible. The 
student now has much laboratory-work, class-demon- 
strations, bedside ward-training, and daily special 
and general clinics; and yet with all this there 
never was a greater rush for post-graduate oppor- 
tunities in the shape of hospital-appointments than 
now. For a time the faculties of our colleges took 
no hand in these scrimmages; but they soon learned 
that it was no small honor to the college to be rep- 
1 Read before the Medical Society of Pennsylvania at the forty- 
fourth annual session, May 15, 1894. 2 
resented in our best hospitals, and hence, during 
the final year of college-work, students that expect 
to apply for hospital-appointments are subjected to 
special training, and a professional quiz is regu- 
larly instituted with a view to give special opportu- 
nities to those desiring them. 
Prior to the present year the diploma of any of 
our chartered medical schools was the only require- 
ment by law for the general practice of one's pro- 
fession in Pennsylvania; but the present State law 
makes a diploma only a passport to the Board of 
State Medical Examiners. 
And what has been the result of the great increase 
of professional chairs, the rivalry for hospital-ap- 
pointments, and the creation of a State Board of 
Medical Examiners ? The answer is only too ap- 
parent, viz., to increase the hardships of the medical 
student. Hard and unsatisfactory as it was when 
he could get his degree in two years, it is doubly 
hard and far more oppressive under the extended 
course. He hears conflicting theories in the lecture- 
room, and sees the results of conflicting treatment 
in the daily clinics. He is expected to pass an 
examination upon oral demonstrations, oral class- 
instruction, oral lectures and clinics from a score of 
specialists, and must depend wholly upon notes, 
meager and almost too hastily taken to be deci- 
phered, with no time or strength to rewrite or 
correct them. A day, a single week at longest, is 
enough to convince the ablest student that he will 
have no time to read, take notes, think, digest, or 
remember, and that he must hire someone to do 
all this for him. Hence has sprung up indispensable 3 
accessories to the class-room, viz., the quiz-masters. 
Sharp, shrewd, wonderfully well-posted men 1 Men 
who know the foibles, the vanities, the eccentricities 
of instructors, and who are masters of the minutest 
detail of every subject-walking encyclopedias, with 
patience and forbearance suited to their callings. 
Quiz-masters have existed for a century, but never 
before were they absolutely essential throughout a 
whole course to the best and ablest students. It is 
not necessary to go into the details of their work. I 
simply say to those who took their degrees fifteen 
or twenty years ago, that they can have no idea of 
the quiz-system of to day. I will pass over the 
quizzing throughout the session, and only allude to 
a single branch. Each student knows a week or so 
before his final examination when he is to "come 
up," and for this he is taken under special training. 
For nine mortal hours, with refreshments to prevent 
interruptions, into the small hours of the morning 
the entire special branch is reviewed. Then a rest 
of one night and a second review for an equal 
length of time. Incredible as this may seem, I 
may add to its incre libility by saying that the 
student after all this will often sit up all night and 
study to the last moment before the final ordeal of 
examination. And this is only for one branch; 
and the same work must be repeated before each 
final examination. If he fails on a single branch, 
he is re-quizzed and comes up a second time. 
All of this for his diploma; then special quizzing 
for hospital-appointments; and finally, the last and 
most feared of all, the State Board ! 
Let us now glance for a moment at the student of 
* 4 
law. In some of our schools he has but a single 
lecture a day, and is at liberty to spend the re- 
mainder with a preceptor or in an office. In some 
schools he has three lectures a day for five days a 
week. About equal to this are the three daily lec- 
tures of the theological student. In the high 
school, academies, and literary colleges, thiee 
recitations a day form the maximum requirement. 
Compare this with the minimum work of the medi- 
cal student, who spends between sixty and seventy 
hours a week in actual, indispensable work. Of all 
students, the medical student is the only one who 
has no Sabbath. 
And now, what of the final result? Does the law- 
student fail to get his diploma? Does the theolo- 
gical student fail? Either may fail, but only when 
extremely lazy, or under grave charges of misde- 
meanor. It is, indeed, rare that the entire class is 
not graduated. Very different is the result in our 
medical schools. In these io per cent, at least of 
every graduating class fail to get their degree; io 
per cent., after paying for three courses of medical 
instruction, three years' maintenance, and three 
years' loss of time. 
Why, it may be asked, do so many fail? 
One fruitful cause of failure is the utter unfitness 
of the student for his work. This should be ascer- 
tained at the preliminary examinations, which in 
medical schools are notoriously farcical. Think of 
" throwing " a man at his final examination because 
he cannot spell or write grammatically ! What earthly 
likelihood is there that a student will pass the 
severest possible examinations on a score of scientific 5 
subjects when his early advantages are too meager 
and too imperfect to gain him entrance to the high 
school ? 
A second reason for failure is that the professor 
knows little or nothing of the student before he 
appears before him for his final examinations. This 
is not so in our literary colleges. In these it is the 
daily, weekly, monthly, class-room work that tells, 
and while I have no authority for stating it, I ven- 
ture the remark that any student at the highest 
literary college in the land might fail in the final 
examinations of each year, and yet receive the 
diploma of the college upon his honest, faithful, 
conscientious class-room work, and what is more, 
his classmates would applaud the action. 
Finally, students fail from sheer exhaustion. The 
long hours of work, often in foul and ill-ventilated 
rooms; the long tension of mind, unrelieved by the 
slightest relaxation ; the magnitude of his work, with 
increasing perplexities every year, and the con- 
stantly menacing horror, that after all he may fail 
of getting his diploma, rob him of sleep and 
render him almost imbecile at the moment when 
his faculties should be freshest and brightest. 
Many a man fails that two months before would 
have passed the ordeal triumphantly. 
If the law of the State demands a four years' 
course of instruction at a medical school, if the law 
demands a diploma as the only possible passport to 
the Board of Medical Examiners, it seems only fair 
that some more legislation is needed to give the 
student that justice which heretofore has never been 
meted out to him. 6 
At the first alumni meeting of the Jefferson Medical 
College, after Dr. Keen had been made professor of 
surgery, he narrated a conversation he had with a 
young man that had failed in his final examinations : 
"I told him that I felt guilty; that I felt that 1 had 
money that belonged to him." I presided at that 
meeting, and as Professor Keen sat down I said : 
" That is the best speech that I ever heard at an 
alumni meeting." There is a suggestion in this that 
I would commend to those who make the laws of 
our State. If the law compels a young man to 
study four years, it ought to give him some guarantee 
that he will be fairly dealt with. Were our medical 
schools compelled to refund one half the expenses 
of the student who fails to get his diploma, if the 
schools were obliged to refund all moneys expended 
on lectures, the graduating class would not be 
reduced in numbers, but the io per cent, that fail 
at their final examinations would have some redress. 
Many of these would be checked at their prelimi- 
nary examinations, while the deserving would get 
more consideration. But this is not all. Were 
medical schools held to a strict accountability for 
their courses of instruction they would soon come to 
a comparison of their methods with the methods of 
other educational institutions, and the result would 
be less quantity but better quality, few failures and 
better men.